Development and standardization of the University of Cincinnati Auditory Processing Inventory (UCAPI)†.

OBJECTIVE: A literature review found that questionnaires for persons with problems of listening seeking assessment of auditory processing skills are not applicable for adolescents and adults. We developed a questionnaire designed for adolescents and adults seeking evaluation of problems with listening or following diagnosis to determine the subject's status. DESIGN: Following a model described by Del Zoppo, Sanchez, and Lind, a 34-item questionnaire was developed that investigates auditory processing abilities in six common areas of complaint in Auditory processing disorders (APD) (Keith, et al. 2017 ). SAMPLE: The questionnaire was administered to 278 typically-achieving young adults and normative values of performance were developed. Validation data were acquired from 3 studies of subjects with language-learning or auditory processing disorders. RESULTS: The total UCAPI score found by combining the totals from the six listening conditions provides an overall value to categorise listening abilities. The listening conditions provide an auditory profile for the person being evaluated. Finally, UCAPI scores obtained from subjects with a previous diagnosis of APD were substantially poorer than typical subjects, data that provide evidence of the validity of questionnaire validity. CONCLUSIONS: Results from the UCAPI can be useful to professionals in helping to make recommendations when diagnosing problems of learning through listening, as well as aid in developing management strategies.

Ocular Vestibular Evoked Myogenic Potentials: Normative Findings in Children.

BACKGROUND: To add to the limited body of literature on ocular vestibular evoked myogenic potential (oVEMP) responses in children and to assess a different montage for oVEMP recording. PURPOSE: To evaluate the characteristics of the oVEMP response in children and compare the results with that of a group of healthy adults. RESEARCH DESIGN: Prospective descriptive study from a tertiary referral center. STUDY SAMPLE: Twenty-two children (mean age = 6.3 yr, standard deviation = ±1.5, range = 3.5-8.9 yr) were recruited from families whose parent(s) were employed by the Cincinnati Children's Hospital Medical Center (CCHMC). Pediatric participants were categorized by age into three groups for data analysis. The comparison adult group of ten participants were members of the employee staff at CCHMC. DATA COLLECTION AND ANALYSIS: Audiometric assessment was completed in all participants. The latency, amplitude, and threshold of the oVEMP responses were recorded using a modified electrode montage with reference at the chin and compared between the pediatric and adult participants. RESULTS: All participants completed testing and had bilateral measurable oVEMP responses using a 105-dB nHL, 500-Hz tone burst stimulus. Comparison between right and left ears across all participants for each oVEMP characteristic found no statistically significant difference. oVEMP testing showed no significant differences with respect to latency, amplitude, interaural amplitude asymmetry, and threshold of response as a function of age. CONCLUSIONS: oVEMP responses for ages ≥3 did not differ from responses in adults.

Altered white matter microstructure underlies listening difficulties in children suspected of auditory processing disorders: a DTI study.

INTRODUCTION: The purpose of the present study was to identify biomarkers of listening difficulties by investigating white matter microstructure in children suspected of auditory processing disorder (APD) using diffusion tensor imaging (DTI). Behavioral studies have suggested that impaired cognitive and/or attention abilities rather than a pure sensory processing deficit underlie listening difficulties and auditory processing disorder (APD) in children. However, the neural signature of listening difficulties has not been investigated. METHODS: Twelve children with listening difficulties and atypical left ear advantage (LEA) in dichotic listening and twelve age- and gender-matched typically developing children with typical right ear advantage (REA) were tested. Using voxel-based analysis, fractional anisotropy (FA), and mean, axial and radial diffusivity (MD, AD, RD) maps were computed and contrasted between the groups. RESULTS: Listening difficulties were associated with altered white matter microstructure, reflected by decreased FA in frontal multifocal white matter regions centered in prefrontal cortex bilaterally and left anterior cingulate. Increased RD and decreased AD accounted for the decreased FA, suggesting delayed myelination in frontal white matter tracts and disrupted fiber organization in the LEA group. Furthermore, listening difficulties were associated with increased MD (with increase in both RD and AD) in the posterior limb of the internal capsule (sublenticular part) at the auditory radiations where auditory input is transmitted between the thalamus and the auditory cortex. CONCLUSIONS: Our results provide direct evidence that listening difficulties in children are associated with altered white matter microstructure and that both sensory and supramodal deficits underlie the differences between the groups.

Left ear advantage in speech-related dichotic listening is not specific to auditory processing disorder in children: A machine-learning fMRI and DTI study.

Dichotic listening (DL) tests are among the most frequently included in batteries for the diagnosis of auditory processing disorders (APD) in children. A finding of atypical left ear advantage (LEA) for speech-related stimuli is often taken by clinical audiologists as an indicator for APD. However, the precise etiology of ear advantage in DL tests has been a source of debate for decades. It is uncertain whether a finding of LEA is truly indicative of a sensory processing deficit such as APD, or whether attentional or other supramodal factors may also influence ear advantage. Multivariate machine learning was used on diffusion tensor imaging (DTI) and functional MRI (fMRI) data from a cohort of children ages 7-14 referred for APD testing with LEA, and typical controls with right-ear advantage (REA). LEA was predicted by: increased axial diffusivity in the left internal capsule (sublenticular region), and decreased functional activation in the left frontal eye fields (BA 8) during words presented diotically as compared to words presented dichotically, compared to children with right-ear advantage (REA). These results indicate that both sensory and attentional deficits may be predictive of LEA, and thus a finding of LEA, while possibly due to sensory factors, is not a specific indicator of APD as it may stem from a supramodal etiology.

Random gap detection test and random gap detection test-expanded: Results in children with previous language delay in early childhood.

OBJECTIVES: The children with difficulty in receiving sounds presented at rapid rates in speech sounds and language learning period, may have delay in speech sounds and language development due to hearing speech sounds not clearly. Auditory temporal processing (ATP) is the ability to perceive auditory signals of brief duration accurately when presented at rapid rates. ATP can be evaluated by the random gap detection test (RGDT), which detects a brief gap between two stimuli. In this study, we investigated performance of children with previous language delay (PLD), currently having disorders in more than one speech sounds, on random gap detection test (RGDT) and RGDT-expanded (RGDT-EXP) tests. METHODS: 12 children (8 male, 4 female) with previous language delay (PLD) and complaint of expressing speech sounds distorted, were included into the study. They had applied language training for at least one-year period in the past and in the current time, their language development is normal. They expressed one or more speech sounds as distorted. The control group consisted of 10 normal hearing children with normal phonological development and language matched for age; and who had not PLD (5 male, 5 female). Children language levels were evaluated by Preschool Language Scale-4 test; or Clinical evaluation of language fundamentals, fourth edition (CELF-4) according to child's age. Speech sounds development was assessed by Speech Sound Development Test (SSDT). They were applied RGDT and/if necessary, RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500-4000 Hz; and Composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT > 20 ms was considered as abnormal for temporal processing disorder. RESULTS: In the study group with PLD, mean of the GDTs were all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group were significantly higher than the control groups at all frequencies of 500-4000 Hz. In PLD group, CGDT (103.53 ± 11.63 ms) was significantly higher than that of the control group, (10.35 ± 0.65 ms) (p=0.021). CONCLUSION: The children with PLD have difficulties in perception of speech sounds at a certain rate, even they have not language learning difficulties. Therefore, difficulty in distinguishing of speech sounds may cause especially receptive language development delay. We believe that perception of the speech sounds and language in a certain speed; and temporally degraded speech programmes should be incorporated into the training programme and may help to prevent delays.

Aging effect on dichotic listening of Cantonese.

Cantonese dichotic digits recognition was evaluated in free-recall, directed-attention right, and directed-attention left response conditions. All participants were right-handed and included a group of young adults with normal hearing and a group of older adults with minimal sensorineural hearing loss. In all conditions, performance by the young adults was better than performance by the older adults. A right-ear advantage was observed for both groups. Due to a greater deficit in dichotic digits recognition performance in the left ear of older subjects their right-ear advantages were larger than those for the young adults. The results support an age-related disadvantage in recognition performance for dichotic stimuli presented to the left ear of older subjects that is not entirely accounted for by differences in hearing sensitivity between subject groups but may be related to a primary cognitive deficit.

Random Gap Detection Test and Random Gap Detection Test-Expanded results in children with auditory neuropathy.

OBJECTIVES: In auditory neuropathy (AN) children with hearing aids (HAs) or cochlear implant (CI), the speech perception improvement may not be in a significant degree. These children may perform speech perception after a few repeats. This condition may show that these children had difficulties in receiving and processing speech sounds. If the children with AN cannot distinguish the heard tones one or two in Random Gap Detection Test (RGDT), their benefit performances between hearing aids or CI may not be significant. It is thought that the answer of this question is closely related with unique auditory processing performance of each child. The aim of the study is to investigate the RGDT and RGDT-Expanded (RGDT-EXP) performance of five children with AN. METHODS: In this study, RGDT was applied to five children with auditory neuropathy between ages of 7 and 13 years (study group) (3 male, 2 female). As a control group, RGDT was applied to 10 normal hearing children who had not auditory processing problem between ages of 7 and 16 years (5 male, 5 female). In the first test, all children were applied to RGDT and RGDT-EXP. Each child responded whether he/she heard one or two tones. Their responses were taken as verbally and/or hold up one finger or two fingers. In the second test, they were applied speech discrimination test in quiet environment and in noise. Gap detection thresholds (GDTs) were detected at 500-4000 Hz; and composite GDTs (CGDTs) were found for the study and control groups. GDT/CGDT>20 ms was considered as abnormal for temporal processing disorder. RESULTS: Any of the children with AN who has no HAs; with HAs; and CI, could not be able to perform RGDT. Therefore the RGDT-EXP was applied in this group. In the study group, GDTs was all over 50 ms at 500-4000 Hz; and CGDTs were all over 50 ms for all children included into the study group with AN. In control group, except child 9 (GDTs were 25 ms at 3000 and 4000Hz); and child 10 (GDT was 25 ms at 500 Hz); GDTs were all in normal limits for 500-4000 Hz for all children included into the study as control group. CGDTs were all in normal limits for the control group, except child 9 (CGDTs were 22.50, slightly higher than normal limits). In the study group with AN, mean of the GDTs was all over the normal limits; and in control group, mean of GDTs were all in normal limits. The difference between the mean GDTs of the study group was significantly higher than the control groups at all frequencies of 500-4000. In AN group, CGDT (97.5+/-9.57 ms) was significantly higher than that of the control group (10.35+/-0.65 ms). CONCLUSION: We concluded that these results may only not be explained by auditory processing performance or temporal aspects of audition of each child. Their gap detection was much worse for short duration stimuli than for longer duration stimuli. The present study showed that temporal processing, auditory timing and gap detection skills of the children with AN were found as delayed in advanced degree. These findings may indicate that the AN children cannot perform temporal asynchrony. Our results may help to understand why the children with AN cannot manage the speech perception; and why they understand the speech after a few repeats.

Peripheral and central auditory dysfunction induced by occupational exposure to organic solvents.

OBJECTIVE: To examine the effects of solvent exposure on hearing function, through an audiological test battery, in a population not occupationally exposed to high levels of noise. METHODS: One hundred ten workers from a coating factory were studied. Jobs at the factory were divided into three different levels of solvent exposure. Hearing status was assessed with a test battery including pure-tone hearing thresholds (0.5-8 kHz), high-frequency hearing thresholds (12 and 16 kHz), and dichotic listening measured through dichotic digits test. Multiple linear regression models were created to explore possible association between solvent exposure and each of the hearing outcomes. RESULTS: Significant associations between solvent exposure and the three hearing outcomes were found. Covariates such as age, gender, race, and ethnicity were also significantly associated with the studied hearing outcomes. CONCLUSIONS: Occupational exposure to solvents may induce both peripheral and central auditory dysfunction. The dichotic digits test seems as a sensible tool to detect central auditory dysfunction associated with solvent exposure. Hearing loss prevention programs may use this tool to monitor hearing in solvent-exposed workers.

Development and standardization of single and double dichotic digit tests in the Malay language.

Single and double dichotic digit tests in Malay language were developed and standardized as an initial attempt to incorporate tests of auditory processing within the scope of audiology practice in Malaysia. Normative data under free recall, directed right-ear first, and directed left-ear first listening conditions were determined using 120 Malay children between the ages of 6 and 11 years old with normal hearing and normal academic performance. Test-retest reliability was assessed in 15 of the study subjects. In general, the double dichotic digit test produced greater differences in scores between age groups, and a greater right-ear advantage than the single dichotic digit test. In addition, the double dichotic digit test also had higher test-retest reliability. These findings suggest the double dichotic digit test is more clinically applicable.

A third-degree burn caused by a neurogenic motor-evoked potential monitoring electrode during spinal surgery: a case report.

STUDY DESIGN: A case report is presented. OBJECTIVE: To report a previously undescribed complication related to use of a neurogenic motor-evoked potential monitoring electrode and electrosurgery during spinal surgery. SUMMARY OF BACKGROUND DATA: Although electrosurgery is one of the most commonly used technologies in the operating room, its electrophysical properties, including the potential for complications, are poorly understood by many surgeons. Complications related to the use of electrosurgical instruments, monitoring electrodes, and radiofrequency current are underreported in the literature. METHODS: Clinical case analysis and investigation report were used. RESULTS: A case of third-degree skin burn at the site of a neurogenic motor-evoked potential monitoring electrode during posterior spinal fusion surgery is described. CONCLUSIONS: A burn resulting from a neurogenic motor-evoked potential monitoring electrode is rare. However, surgeons and electrophysiologists should be familiar with this potential complication in order to prevent it.

Clinical Issues in Central Auditory Processing Disorders.

Speech-language pathologists are often faced with the need to assess and treat the suspected auditory processing problems of children with language and learning difficulties. This article discusses central auditory processing disorders (CAPDs). Included are a discussion of background information, a current definition of CAPDs, a general discussion of test battery approaches following suggestions made by the American Speech-Language- Hearing Association (ASHA) Task Force on Central Auditory Processing Consensus Development (1996), and various approaches to intervention with persons identified as having a CAPD. Finally, there is brief discussion of remaining questions to be answered. The article attempts to examine various controversies related to all aspects of CAPDs and increase the reader's awareness of current issues concerning this disorder.

Assessment of auditory processing in children with attention deficit hyperactivity disorder and language-based learning impairments

Objetiva fornecer informação sobre dois testes de desordens do processamento auditivo central, do teste de sentenças com competição e de um teste para desordens do processamento temporal denominado Teste de Fusão Auditiva-Revisado - AFT-R. Objetiva também, mostrar os resultados desses testes quando aplicados em duas populações. Limiares de fusão auditiva e escores do teste de sentenças com competição de 18 crianças com Déficit de Atenção e Hiperatividade - ADHD, e 17 crianças com problemas de linguagem - LLI foram investigadas usando o AFT-R e o teste de sentenças com competição - CST. Os resultados foram comparados aos valores normativos publicados previamente. Observou-se diferença significativa entre os grupos com relação aos limiares de fusão auditiva: as crianças com ADHD apresentaram limiares mais pobres, piores, do que as crianças com LLIe as crianças normais. As crianças com ADHD tiveram uma média mais alta, resultados piores, e um desvio padrão maior de limiares de fusão auditiva do que os encontrados em crianças normais e naquelas com LLI. Nenhuma diferença significativa foi encontrada entre os grupos - ADHD e LLI, no teste de sentenças com competição à direita - CST-R e com competição à esquerda - CST-L. Observou-se diferença significativa de performance entre as crianças normais, as crianças com ADHD e as crianças com LLI nos testes CST-R e CST-L. As implicações clínicas desses resultados são discutidas (AU)

Assessment of auditory processing in children with attention deficit hyperactivity disorder and language-based learning impairments

Objetiva fornecer informaçäo sobre dois testes de desordens do processamento auditivo central, do teste de sentenças com competiçäo e de um teste para desordens do processamento temporal denominado Teste de FusäoAuditiva-Revisado - AFT-R. Objetiva também, mostrar os resultados desses testes quando aplicados em duas populaçöes. Limiares de fusäo auditiva e escores do teste de sentenças com competiçäo de 18 crianças com Déficit de Atençäo e Hiperatividade - ADHD, e 17 crianças com problemas de linguagem - LLI foram investigados usando o AFT-R e o teste de sentenças comcompetiçäo - CST. Os resultados foram comparados aos valores normativos publicados previamente. Observou-se diferença significativa entre os grupos com relaçäo aos limiares de fusäo auditiva: as crianças com ADHD apresentaram limiares mais pobres, piores, do que as crianças com LLIe as crianças normais. As crianças com ADHD tiveram uma média mais alta, resultados piores, e um desvio padräo maior de limiares de fusäo auditiva do que os encontrados em crianças normais e naquelas com LLI. Nenhuma diferença significativa foi encontrada entre os grupos - ADHD e LLI, no teste de sentenças com competiçäo à direita - CST-R e com competiçäo à esquerda - CST-L. Observou-se diferença significativa de performance entre as crianças normais, as crianças com ADHD e as crianças com LLI nos testes CST-R e CST-L. As implicaçöes clínicas desses resultados säo discutidas